Jessica R. Szabo

The Court of Appeal for Ontario considered when a gender affirming surgery, specifically a vaginoplasty without penectomy, qualifies as an insured service under the Ontario Health Insurance Plan (OHIP).

The court held that vaginoplasty is a specifically listed insured service in the Schedule of Benefits, regardless of whether it is accompanied by a penectomy, and that the exclusion for experimental procedures does not apply to specifically listed services.

The appeal by the General Manager of OHIP was dismissed.

The appellant, found not criminally responsible (NCR) for past offences, appealed a disposition by the Ontario Review Board that ordered his detention at a forensic mental health facility with community privileges, rather than granting his request for a conditional discharge.

The Board denied the conditional discharge due to public safety concerns, emphasizing the need for swift intervention in case of mental state decompensation, despite the appellant's recent stability.

The Court of Appeal dismissed the appeal, finding the Board's decision reasonable.

The court deferred to the Board's expert opinion, supported by the appellant's psychiatrist, that a detention order was necessary to ensure public protection by allowing intervention before the criteria for involuntary admission under the Mental Health Act were met, which conditional discharge mechanisms might not adequately provide.

The appellant, found not criminally responsible due to mental disorder for attempted murder, appealed the Ontario Review Board's conditional discharge order.

The Board found he continued to pose a significant threat to public safety, rejecting his treating physician's low-risk assessment due to insufficient factual grounding and limited self-reports.

The Court of Appeal dismissed the appeal, affirming that the Board did not abdicate its inquisitorial role and its decision was reasonable and supported by the record.

The appellant, an Indigenous individual found not criminally responsible on account of mental disorder (NCRMD), appealed the Ontario Review Board's refusal to order a Gladue Report for his next annual review.

The Board had deemed the report premature, suggesting it would be more beneficial after further treatment stability.

The Court of Appeal found the Board's refusal unreasonable, emphasizing its duty to gather all relevant evidence, including Gladue information, for Indigenous NCR accused persons.

The court reiterated that Gladue principles apply to Board proceedings and require a distinct analytical approach.

The appeal was allowed, and the Board was ordered to ensure a Gladue Report is prepared before the appellant's next hearing.

The appellant, found not criminally responsible for aggravated assault, appealed a disposition order from the Ontario Review Board (ORB) that directed his transfer from Ontario Shores Centre for Mental Health Sciences to the Centre for Addiction and Mental Health (CAMH).

The ORB's decision was based on the recommendation of the appellant's treating psychiatrist, who believed CAMH's sexual behaviour clinic was necessary to address the appellant's hypersexuality and concerning behaviours.

The Court of Appeal reviewed the ORB's decision on a reasonableness standard, as established in R. v. Owen, and found that the ORB's analysis and conclusion were reasonable and supported by the evidence.

The appeal was dismissed.

M.F. appealed a decision affirming his incapacity to make treatment decisions regarding antipsychotic medication.

The Consent and Capacity Board and the Superior Court of Justice had previously confirmed Dr. Milovic's finding of incapacity.

The Court of Appeal dismissed the appeal, finding that the Board properly weighed the evidence, including the medical opinion that M.F.'s psychosis was due to schizophrenia, not drug-induced psychosis, despite arguments about cannabis use.

This appeal concerned a decision by the Consent and Capacity Board (CCB) affirming a finding that the appellant was incapable of consenting to antipsychotic and mood-stabilizing medications.

The appellant, who was self-represented, did not appear at the appeal hearing, but amicus curiae provided submissions.

The court admitted fresh evidence regarding mootness but ultimately found the appeal was not moot due to the appellant's ongoing interactions with the mental health system and the potential relevance of a prior capable wish.

The court reviewed the CCB's application of the capacity test under the Health Care Consent Act, 1996, and its consideration of the appellant's religious beliefs.

The court found no reviewable errors by the CCB, concluding that the CCB's finding on the appellant's inability to appreciate the foreseeable consequences of treatment was sufficient, and that the appellant's religious beliefs were a manifestation of his mental condition, not a genuine religious objection.

The appeal was dismissed.

L.L. appealed a decision of the Consent and Capacity Board that found him incapable of consenting to psychiatric treatment.

The Board had determined that L.L. met the criteria for involuntary detention and lacked the ability to appreciate the reasonably foreseeable consequences of a decision about treatment with antipsychotic and mood stabilizing medications, primarily due to a mental disorder (likely bipolar I with psychotic elements).

The Superior Court dismissed L.L.'s appeal, upholding the Board's finding of incapacity and its procedural fairness.

The court also addressed the admission of fresh evidence and the Board's decision not to appoint amicus curiae, finding no error in either.

The respondent brought a motion to admit fresh evidence and to dismiss the appellant's appeal from a Consent and Capacity Board decision for delay or as moot.

The court admitted the fresh evidence without requiring leave, finding it relevant to the motion.

The court found the appeal should be dismissed for delay due to the appellant's two-year inaction and relocation to the Congo, and also found the appeal moot as the appellant had been discharged from treatment and the capacity issue was no longer a live dispute.

The motion was granted, and the appeal was dismissed.

The appellant appealed two dispositions of the Ontario Review Board.

The first disposition, which transferred him to the Centre for Addiction and Mental Health (CAMH), was dismissed as moot by the Court of Appeal as it had been superseded.

The second disposition, which ordered his detention at the highly secure Waypoint Centre for Mental Health Care due to worsening behaviour and significant threat to public safety, was upheld.

The court found the Board's decision reasonable, emphasizing that public safety, including the safety of hospital staff and co-patients, is the paramount consideration under s. 672.54 of the Criminal Code, and deferred to the Board's expertise in managing the risk posed by the individual.

This is an appeal from a disposition of the Ontario Review Board concerning a restriction of liberty hearing for an appellant found not criminally responsible on account of mental disorder (NCR) for aggravated assault.

The appellant, who has schizophrenia, had his liberty restricted and was transferred to a more secure forensic unit after his mental health deteriorated due to discontinuing medication.

The appellant argued that the Board failed to consider his liberty interests and other needs, including a request for a lateral transfer to another unit, and that the Board's findings were unreasonable.

The Court of Appeal found that the Board considered all required factors and that there was sufficient evidence to support the transfer to a more secure unit, including testimony from the treating psychiatrist regarding the appellant's unmanageability and risk of harm.

The Court dismissed the appeal, finding the Board's conclusion that the restriction of liberty was necessary to be reasonable.

This is an appeal to the Court of Appeal for Ontario concerning a patient's capacity to consent to psychiatric treatment.

The appellant, diagnosed with schizophrenia, was found incapable by the Consent and Capacity Board of consenting or refusing antipsychotic medication, a decision upheld by the Superior Court.

The core issue was whether the appellant could appreciate the reasonably foreseeable consequences of his treatment decision, particularly in light of his delusional beliefs about environmental factors affecting his health.

The Court of Appeal affirmed that the Board correctly applied the two-branch capacity test under the Health Care Consent Act, 1996, as interpreted by the Supreme Court in Starson v. Swayze, which requires a patient to recognize how their mental condition's manifestations affect them.

The Court found no error in the Board's factual findings or its application of the legal standard, concluding that the appellant's decision was dictated by his delusions, preventing a rational appreciation of treatment benefits.

The appeal was dismissed.

The Appellant appealed a decision of the Consent and Capacity Board which found him incapable of consenting or refusing to consent to antipsychotic medication.

The central issue was the second branch of the capacity test under the Health Care Consent Act, specifically whether the Appellant could "appreciate the reasonably foreseeable consequences" of his decision, given his delusional beliefs about environmental afflictions and the effects of medication.

The court dismissed the appeal, affirming that capacity requires an objectively reasonable appreciation of risks and benefits, not one rooted in delusions, even for an intellectually capable individual.

Stanley Almeida, a patient with delusional disorder, appealed a Consent and Capacity Board decision finding him incapable of consenting to or refusing treatment.

Dr. Andrew Morgan, his psychiatrist, brought a motion for an interim order to administer intravenous antipsychotic medication (Invega Sustenna) pending the appeal's resolution.

The court denied Almeida's adjournment request, citing urgency due to his deteriorating health and the unlikelihood of counsel being available quickly.

Applying the criteria under s. 19 of the Health Care Consent Act, the court found that the treatment would substantially improve Almeida's condition, benefits outweighed risks, it was the least restrictive option given his non-compliance, and it was necessary before the appeal.

The motion was granted, authorizing treatment until the appeal is resolved, and the appeal was expedited.

J.G. appealed a Consent and Capacity Board decision confirming his incapacity to consent to mental disorder treatment.

Despite J.G.'s non-attendance and failure to advance the appeal, the Superior Court of Justice proceeded, admitting fresh evidence regarding J.G.'s post-discharge condition and the respondent's efforts to contact him.

Applying appellate standards of review, the court found no palpable and overriding error in the Board's factual findings regarding J.G.'s mania and grandiosity preventing him from appreciating his condition or treatment consequences.

The appeal was denied.

J.W. appealed a Consent and Capacity Board decision confirming her incapacity to consent to mental disorder treatment.

Despite J.W.'s non-attendance and lack of engagement in the appeal process, the Superior Court of Justice proceeded with the appeal, admitting fresh evidence regarding J.W.'s hospital attendances and the respondent's efforts to contact her.

Applying appellate standards of review, the court found no palpable and overriding error in the Board's factual findings and denied the appeal, upholding the incapacity finding.

W.S., a 20-year-old with significant mental health issues, appealed a Consent and Capacity Board decision that found her incapable of managing property.

The Board's finding was based on her inability to appreciate the foreseeable consequences of acquiring alcohol, leading to self-harm.

The Superior Court of Justice found that the Board committed an error of law by characterizing the decision to acquire alcohol as a decision in property management without other evidence of property management issues, and that the physician's assertion of W.S. "repeatedly running out of money" was uncorroborated.

The court emphasized that capacity to manage property must relate to financial matters, not solely to control behavior unrelated to property.

The Board's finding of incapacity was set aside.

The appellant, Anderson Tung, appealed a decision of the Consent and Capacity Board which found him incapable of consenting to treatment with anti-psychotic medications due to his inability to appreciate the foreseeable consequences of his decision.

The Board's finding was based on evidence of his delusions and denial of mental illness.

The Superior Court of Justice dismissed the appeal, upholding the Board's decision under a reasonableness standard, finding sufficient evidence to support the conclusion that the appellant lacked capacity to appreciate the consequences of his treatment decision.

The respondent brought a motion to dismiss an appeal from a Consent and Capacity Board decision concerning the appellant's capacity to consent to treatment.

The court found the appeal moot because the appellant had been discharged from the hospital almost five years prior, had no further contact with the mental health system, and the issue of capacity is time-specific.

The court declined to exercise its discretion to hear the moot appeal, concluding there was no live controversy, no practical effect on the parties' rights, no continuing adversarial relationship, and no special circumstances, including reputational concerns, to warrant the use of judicial resources.